New Podcast Series Focuses on Managing Patients With a Declining Functional Status

Establishing appropriate and realistic goals and expected
outcomes for patients with a declining functional status can be challenging –
knowing that the ultimate trajectory of function is expected to be downward. A
new APTA podcast series addresses the challenges
of and suggests solutions for managing the care of these patients, who may have
conditions such as Parkinson disease, muscular sclerosis, cystic fibrosis, or
late-stage congestive heart failure.

The first podcast
begins with general functional status and safety examples. In upcoming podcasts
physical therapists will share their experiences in applying these principles
to specific patients with conditions that are characterized by a declining
functional status.

Benefits of Self-management for LBP Not Considered 'Worthwhile' by Patients

Self-management
interventions are widely recommended for patients with low back pain (LBP), but
a meta-analysis by Australian researchers suggests that its effects on pain and
disability are likely to be small and are supported by only moderate-quality
evidence, says a Medscape Medical News article.

The researchers included randomized controlled trials evaluating
self-management for nonspecific LBP and assessing pain and disability in their
review. They pooled data when studies were similar enough and divided analyses
into short-term (less than 6 months after randomization) and long-term (at
least 12 months after randomization) outcomes.

They found 13 original trials that met inclusion criteria. Efficacy of
self-management (including shared responsibility for a plan of care,
self-monitoring, and management of signs and symptoms) was compared with
efficacy of minimal intervention and with other interventions such as massage,
acupuncture, yoga, and exercise.

"The improvement [in pain and disability] was less than what is
generally considered worthwhile by patients," said lead author Vincinius
C. Oliveira. Specifically, the short-term improvement was -3.2 points on a
100-point scale for pain and -2.3 points for disability. According to the
authors, effect sizes of 20% to 30% are needed for patients to consider
interventions worthwhile.

Dawn Carnes, DO, director of the National Council for Osteopathic Research
and senior research fellow at the London School of Medicine and Dentistry in
the United Kingdom, told Medscape that
she was surprised by the strength of the authors' conclusion because small
changes in large populations (such as LBP) do make a difference at a population
level.

Carnes also voiced concerned about the review's inclusion criteria. She
said, "[The authors] included all types of [LBP], including chronic. Why
would you expect pain to improve in a chronic pain population, where drugs
don't even work for these people? Similarly, disability is unlikely to change
in chronic patients, especially those with permanent bony or physiological
change."

The researchers told Medscape that
they "were surprised by lack of definition criteria for self-management.
The study raised questions that our group is currently working on such as
consensus on what self-management for [LBP] is among experts, including
clinicians and researchers."

In comparing self-management with minimal intervention, the authors found
"moderate-quality evidence that self-management interventions have small
but statistically significant effects, compared to minimal interventions, on
pain and disability for LBP."

In addition, they found only low-quality evidence that self-management is
not better than massage, acupuncture, yoga, and exercise in reducing pain or
disability in LBP.

The study was published online October 27
and in the November print issue of Arthritis Care & Research.

Physical
activity, including walking on a treadmill and stretching and resistance
exercise, appears to improve gait speed, muscle strength, and fitness for
patients with Parkinson disease, say researchers at the University of Maryland. Their article is published online in Archives of Neurology.

The
researchers compared 67 people with Parkinson disease who were randomly
assigned to 1 of 3 exercise groups: walking on a treadmill at low intensity for
50 minutes, higher-intensity treadmill training to improve cardiovascular
fitness for 30 minutes, and using weights (leg presses, extensions and curls)
and stretching exercises to improve muscle strength and range of motion.
Participants exercised 3 times a week for 3 months under the supervision of
exercise physiologists at the Baltimore VA Medical Center.

The
investigators found improved cardiovascular fitness in both the higher- and
lower-intensity treadmill exercise groups. However, only the stretching and
resistance exercises improved muscle strength (16% increase) during the study.

"We
are encouraged to see that the lower-intensity treadmill exercise, which is
feasible for most Parkinson patients, proved to have the greatest benefit for
mobility while also improving cardiovascular fitness," said Lisa Shulman,
MD, the study's principle investigator.

E. Ray Dorsey, MD, coauthor of an accompanying journal editorial,
told HealthDay News, "I hope this study adds to the
evidence that exercise should be the standard of care."